Esophageal composite carcinoma with tripartite differentiation: clinicopathological analysis of three cases

Abstract

We here report on the clinicopathological characteristics of three cases of esophageal composite tumor showing tirpartite differentiation toward distinct squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. All tumors had in situ squamous cell carcinoma components and the deeply invasive parts of adenocarcinoma and small cell carcinoma components, which showed positive immunoreactivity for neuroendocrine markers and intracytoplasmic argyrophil granules. All three patients suffered disseminated tumor recurrence soon after esophagectomy and died of the disease within 14 months after operation. The metastatic tumors were predominantly composed of small cell carcinoma, and serum levels of neuron-specific enolase (NSE) were abnormally elevated at the time of recurrence in all cases. Esophageal composite tumors with tripartite differentiation are extremely aggressive; this aggression is primarily the result of the small cell carcinoma component, indicating the necessity for clinicians to treat such tumors as small cell carcinoma.